Basic Information
| Provider Information | |||||||||
| NPI: | 1760436265 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SANTANA | ||||||||
| FirstName: | JOSE | ||||||||
| MiddleName: | RAMON | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 10744 | ||||||||
| Address2: | |||||||||
| City: | CLEARWATER | ||||||||
| State: | FL | ||||||||
| PostalCode: | 337578744 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7275320002 | ||||||||
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| Practice Location | |||||||||
| Address1: | 2531 LANDMARK DR | ||||||||
| Address2: | SUITE 103 | ||||||||
| City: | CLEARWATER | ||||||||
| State: | FL | ||||||||
| PostalCode: | 337613932 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7277964396 | ||||||||
| FaxNumber: | 8136357867 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/20/2006 | ||||||||
| LastUpdateDate: | 04/27/2010 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | ME78516 | FL | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 110196139 | 01 | FL | RAILROAD MEDICARE NUMBER | OTHER | 257174900 | 05 | FL | MEDICAID |